4 TABLE OF CONTENTS Page Executive Summary... i Context/Introduction...1 Statement of 14 Principles for Minority Health Equity...4 Statement of Three Recommendations... 6 Discussion of the 14 Principles...7 Principles 1-4 Principles 5-8 A Diverse Health Care Workforce with Diverse Executive Leadership and Governance.. 7 Equitable and Sustainable Access to Comprehensive and Affordable Health Care Coverage and Services...11 Principles 9-11 Preserve Safety Net, Focus on Community Engagement and the Social Determinants of Health, Promote Partnerships with Public Health...15 Principles Data Systems Ensure Comprehensive Capacity and Multi-Dimensional Accountability for Eliminating Disparities as well as Achieving Reform...19 Discussion of the Three Recommendations...21 Recommendation 1: to develop and establish a Federal Health Equity Commission (akin to the Federal Civil Rights Commission) that will focus on eliminating health disparities in the US. The Health Equity Commission will provide the stature and clout demonstrably necessary to begin to achieve sustained progress toward the elimination of health disparities/inequities. Recommendation 2: In the meantime, all health care reform commissions, committees, and working groups whether federal or state or local governmental and legislative, public or private think-tank/ngo, must take steps to include sub-committees that address health disparities/inequities, minority health equity, and workforce diversity. It is equally important that these entities take meaningful steps to ensure diversity reflective of communities served in their leadership, membership, and staffing. Recommendation 3: The 14 Principles for including Minority Health Equity in Health Care Reform must be thoroughly considered/addressed in writing by all entities described in Recommendation 2. These reports must be delivered to the Secretary of US Health and Human Services and the Federal Health Equity Commission

5 Endnotes...26 Executive Summary ii

6 Of all the forms of inequality, injustice in health is the most shocking and the most inhumane. Dr. Martin Luther King Jr. at the 2nd National Convention of the Medical Committee for Human Rights on March 25, 1966 Executive Summary Health and health care disparities have disproportionately affected minority communities across the US health care system. In 2003, the Institute of Medicine (IOM) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, urged that eliminating disparities become a national priority. Despite this call to arms, the 2008 National Healthcare Disparities Report (NHDR) shows that health disparities are actually increasing in many areas and remain unchanged in others. For example, the proportion of new AIDS cases was 9.4 times as high for Blacks as for Whites and three times as high for Hispanics as non Hispanics. Minority communities (i.e., Blacks, Hispanics, American Indians/Alaskan Natives, some Asian Americans and Native Hawaiians and Other Pacific Islanders) continue to be vulnerable communities who are disproportionately poorer, and disproportionately uninsured or underinsured. Minority communities continue to experience disproportionately higher morbidity and mortality rates for disabling chronic diseases such as diabetes, kidney disease, heart disease, and cancer. Well-regarded research suggests that 83,000 deaths each year are attributable to racial and ethnic health disparities. The unprecedented economic downtown in the latter half of 2008 combined with the increasingly dire effects of high health care costs for both businesses and individuals have set in motion unique/concerted efforts to achieve meaningful health care reform in Meaningful health care reform offers the potential to improve the health status in minority and vulnerable communities, and to reduce/eliminate health disparities. But, if the past is not to be the prologue, then health care reform must intentionally establish the strategies necessary to ameliorate and ultimately to eliminate minority health disparities. Otherwise, the myriad challenges of health care reform could mean that minority health priorities receive insufficient consideration. Every strategic aspect of health care reform currently being considered, from health insurance coverage to health care access to patient-centered comprehensive services to expanding primary care providers to improving quality of care by improving health care provider training also has the potential to ameliorate health disparities and improve the health of minority communities. Consequently, the Advisory Committee on Minority Health (ACMH) asserts that every such health care reform proposal/strategy must be assessed/evaluated regarding its implications and impact for ameliorating health disparities and improving the health of minority communities. To facilitate this necessary/critical scrutiny, the ACMH proposes 14 Principles to provide the necessary evaluative criteria. These principles encompass scientifically well- Executive Summary i

7 established areas of health care policy and health care reform including the need for a diverse health care workforce, equitable access to comprehensive health care coverage and services, the key roles of public health and the safety net, and the need for transparent, accessible, and comprehensive data systems. The ACMH urges application of the following 14 Principles to ensure that health care reform will meet the health care needs of minority communities, and create the impetus and infrastructure to eliminate health disparities/inequities. The ACMH also proposes three overarching Recommendations to facilitate/support application of the 14 Principles. A Diverse Health Care Workforce with Diverse Executive Leadership and Governance Principle 1: The development of a health care workforce that is truly representative and reflective of the communities served is vital for health care reform to achieve its full potential to serve a diverse and growing minority population and to create an affordable and sustainable health care system that produces good health outcomes. Principle 2: The development of diverse executive leadership and governance bodies of the health care system is essential for implementing effective health care reform that meets the needs of a diverse minority population and ensures/works for the elimination of health disparities/inequities. Principle 3: Accrediting and licensing agencies must include strong and robust requirements/benchmarks and oversight processes for ensuring the provision of patientcentered, culturally and linguistically sensitive/competent care in all health care settings. These benchmarks must ensure a diverse health care workforce with diverse executive leadership and governance. Principle 4: Health care professional schools must be affordable and must reflect the diverse communities they serve. Their curricula must promote a trans- and multidisciplinary, team-oriented, and community-responsive approach to teaching, training, mentoring, and matriculating in order to ensure the availability of primary care health care providers necessary to implement comprehensive health care reform. Equitable and Sustainable Access to Comprehensive and Affordable Health Care Coverage and Services Principle 5: High quality health care coverage that is affordable and comprehensive must be equally accessible to all individuals regardless of nativity or citizenship, age or health history. Coverage should be portable to eliminate gaps in coverage due to transitions in employment or life circumstance. Minority and vulnerable communities are Executive Summary ii

8 disproportionately affected by lack of coverage and access and the consequences of poor health status. Principle 6: A redesigned health care system must be patient-centered and promote a medical home or more broadly a health home for everyone. To improve access for minority and vulnerable communities, financing and reimbursement policies must incentivize and ensure that all persons residing in the US have a health home that emphasizes prevention, primary care, chronic care management and care coordination, and providing patient-centered, culturally and linguistically sensitive/competent care. Principle 7: Health care reform must support the enhancement and availability of a wide range of community-based interventions and programs that are responsive to diverse populations, in particular, minority and vulnerable communities. Coordination of patient-centered, culturally and linguistically sensitive/competent care across primary care and medical specialties and sub-specialties must be encouraged through financing and reimbursement systems. Principle 8: While health care reform must create a financially sustainable health care system, new or revised financing and reimbursement policies must not adversely and/or disproportionately affect minority and vulnerable communities. Indeed, such financing and reimbursement policies must redirect resources to minority and vulnerable communities who have always experienced a disproportionate lack of access to the health care system and disproportionately poor health status. Preserve the Safety Net, Focus on Community Engagement and the Social Determinants of Health, Promote Partnerships with Public Health Principle 9: A robust safety net must be maintained to insure that vulnerable and minority populations do not fall through the cracks. Minority and vulnerable communities are those who not able to access affordable health care coverage and/or services and thus disproportionately rely on the safety net, e.g., children in immigrant families, lowincome parents, low-wage working adults with no children, some lawfully residing residents, and undocumented residents in the U.S. Principle 10: Health care reform must include minority communities as key stakeholders to provide direct input as to how health care should be structured and delivered. Strong and active minority and vulnerable community engagement is the essential foundation for establishing successful strategies to eliminate health disparities that include meaningful prevention strategies and that account for/address the social determinants of health (SDOH). Principle 11: The public health infrastructure must be strengthened to assure that its primary functions and activities are responsive to a diverse population, especially minority and vulnerable communities, and account for/address the social determinants of health (SDOH). Health departments must have the ability to hold their agencies Executive Summary iii

9 accountable for health disparities as well as the capacity to deal/work with diverse populations in public health emergencies. Minority and vulnerable communities represent a particular challenge/responsibility for public health because these communities disproportionately lack access to health care and health homes. Data Systems Ensure Comprehensive Capacity and Multi-Dimensional Accountability for Eliminating Disparities as well as Achieving Reform Principle 12: The developing area of Health Information Technology (HIT) must support the delivery of a continuum of patient-centered, culturally and linguistically sensitive/ competent care that is seamless and coordinated. HIT through its datacollection must be used for quality assurance and improvement aimed at eliminating health disparities/inequities. HIT must go beyond the hospital to include communitybased providers and programs that serve minority and vulnerable communities. Principle 13: Data collection strategies must be designed to recognize, measure, evaluate, and address the social determinants of health (SDOH) within the context of the health care system and strategies to improve health outcomes, promote quality assurance, and eliminate health disparities/inequities. SDOH includes environmental influences such as poor housing, unsafe neighborhoods, lack of access to fresh foods, and polluted environments as well as personal behaviors. Principle 14: Data collection strategies, including information on quality, performance, and outcomes, must be transparent and consistent with the benchmarks for eliminating health disparities/inequities as established by the Secretary of HHS or by the federal Health Equity Commission. Measures relevant to and informative of minority and vulnerable communities have been disproportionately absent from data collection and measurement strategies this situation must be corrected. The Advisory Committee on Minority Health makes three overarching Recommendations to ensure that the foregoing 14 Principles for Minority Health Equity are effectively incorporated into health care reform activities so that health care reform will meet the needs of minority communities and create the impetus and infrastructure to eliminate health disparities: Recommendation 1: The Administration and the Congress shall take steps to develop and establish a Federal Health Equity Commission (akin to the Federal Civil Rights Commission) that will focus on eliminating health disparities in the US. The Health Equity Commission will provide the stature and clout demonstrably necessary to begin to achieve sustained progress toward the elimination of health disparities/inequities. Executive Summary iv

10 Recommendation 2: In the meantime, all health care reform commissions, committees, and working groups whether federal or state or local governmental and legislative, public or private think-tank/ngo, must take steps to include sub-committees that address health disparities/inequities, minority health equity, and workforce diversity. It is equally important that these entities take meaningful steps to ensure diversity reflective of communities served in their leadership, membership, and staffing. Recommendation 3: The 14 Principles for including Minority Health Equity in Health Care Reform must be thoroughly considered/addressed in writing by all entities described in Recommendation 2. These reports must be delivered to the Secretary of US Health and Human Services and the Federal Health Equity Commission. Executive Summary v

11 Ensuring that Health Care Reform Will Meet the Health Care Needs of Minority Communities and Eliminate Health Disparities A Statement of Principles and Recommendations U.S. Department of Health and Human Services Advisory Committee on Minority Health (ACMH) FULL REPORT

12 Statement of 14 Principles and Three Recommendations Designed to Ensure that Health Care Reform Will Meet the Health Care Needs of Minority Communities and Eliminate Health Disparities Of all the forms of inequality, injustice in health is the most shocking and the most inhumane. Dr. Martin Luther King Jr. at the 2nd National Convention of the Medical Committee for Human Rights on March 25, 1966 Consequences of the History of Disparities in US Health Care System Health and health care disparities have disproportionately affected minority communities across the US health care system. In 2003, the Institute of Medicine (IOM) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, urges that eliminating disparities become a national priority. Despite this call to arms, the 2008 National Healthcare Disparities Report (NHDR) shows that health disparities are increasing. 1 Minority communities (i.e., Blacks, Hispanics, American Indians/Alaskan Natives, some Asian Americans and Native Hawaiians and Other Pacific Islanders) continue to be vulnerable communities disproportionately poorer, and disproportionately uninsured or underinsured Minority communities continue to disproportionately experience higher morbidity and mortality rates for disabling chronic diseases such as diabetes, kidney disease, heart disease, and cancer. 2 Well-regarded research suggests that 83,000 deaths each year are attributable to racial and ethnic health disparities. 3 The US has a long history of inequities in health care yet the scientific study of health care disparities is a relatively new field. 4 Publicity and public concern regarding health care disparities have increased dramatically in the last ten years. Federal and state governments, leading health care foundations and major employers have called attention to disparities in treatment and outcomes and to the urgent need to develop effective interventions. Some federal initiatives, such as the Healthy People 2010 initiative, explicitly target reduction in disparities. Today, 13 of the nation s 48 state offices of minority health specifically identify disparity reduction or equity in their name, 5 and industries from hospitals to health insurance companies are working to ameliorate disparities by investing substantial resources in quality improvement efforts for all Americans. 6 Even with the increased attention and advances in the quality of care, persistent racial and ethnic health disparities continue to plague the US health care system. Hundreds Full Report 1

13 of studies have documented substantial gaps in access, quality of care and health outcomes by race, ethnicity, socioeconomic status, and gender. 7 Notable examples include surgical outcomes, access to ambulatory services, and outcomes for heart disease and certain cancers. 8 African-American women are 67 percent more likely to die when diagnosed with breast cancer. 9 Hispanics with HIV are almost 30 percentage points less likely to receive protease inhibitors during treatment; 10 poor individuals score lower on 11 of the 17 core measures of quality care than high-income individuals; 11 African Americans wait two times as long for kidney transplantation. 12 Women are less likely to receive evidence-based testing and treatment for heart disease than men. 13 Asian American and Pacific Islander women have low rates of cancer screening including mammograms and Pap tests. According to Kagawa-Singer and Pourat (2000), in the United States, 26% of Chinese, 21% of Japanese, 28% of Filipinos, 50% of Koreans, and 68% of Asian Indians (all over the age of forty) had never had a mammogram. Furthermore, one fifth of Asian American women (over the age of eighteen) have never had a Pap test, and among those who have, one out of seven have not had the test within the past three years. 14 When mortality rates are used as the indicator of health outcomes, American Indians and Alaska Natives face a disadvantage, relative to Whites, at each stage of the life span, with persistent disparities in infant mortality, life expectancy, and mortality from a variety of conditions including chronic diseases. 15 There is also sufficient evidence of disparities in health care financing, access to care, and quality of care to conclude that 16 American Indians and Alaska Natives are disadvantaged in the health care system. The National Healthcare Disparities Report, 2008 (NHDR) produced by the Agency for Healthcare Research and Quality (AHRQ) provides in its introductory section a succinct but powerful description of the state of health care for minorities and other vulnerable groups in the US: Disparities persist in health care quality and access - For AI/ANs, 75% of the core measures that could be tracked over time improved (gap decreased). For Blacks and Asians, 60% of the core measures used to track access remained unchanged (gap stayed the same) or got worse (gap increased). For Hispanics, 80% of core access measures remained unchanged or got worse. For poor populations, 57% of core access measures remained unchanged or got worse. Magnitude and pattern of disparities are different within subpopulations - Improvements in preventive care, chronic care, and access to care have led to the elimination of disparities for some priority populations in areas such as mammograms, smoking cessation counseling, and appropriate timing of antibiotics. At the same time, many of the largest disparities have not changed significantly. Some disparities exist across multiple priority populations - In addition to the variable distribution of disparities evident across priority populations, in some cases several different populations experience the same gaps in care as other populations due to poor quality overall or populations experiencing similar barriers. Full Report 2

14 According to a new study by the Kaiser Family Foundation, and a decade after US Surgeon General David Satcher called for the elimination of racial disparities in health, women of color in every state continue to fare worse than white women on a variety of measures of health, health care access and other social determinants of health. The June 2009 report -- Putting Women s Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level -- documents the persistence of disparities on 25 indicators between white women and women of color, including rates of diseases such as diabetes, heart disease, AIDS and cancer, as well as insurance coverage and health screenings. Women of color fared worse than white women on most measures and in some cases the disparities were stark. National statistics mask substantial state-by-state variation in disparities. The report moves beyond national figures to quantify where disparities are greatest, providing new information to help determine how best to combat the problem. The analysis also provides new state-level data for women that are often difficult to obtain. 17 Urgent Need for Minority Health to Inform Health Care Reform Deliberations The unprecedented economic downtown in the latter half of 2008 combined with the increasingly dire effects of high health care costs for both businesses and individuals have set in motion unique/concerted efforts to achieve meaningful health care reform in Meaningful health care reform offers the potential to improve the health status in minority and vulnerable communities, and to reduce/eliminate health disparities. But, if the past is not to be the prologue, then health care reform must intentionally establish the strategies necessary to ameliorate and ultimately to eliminate minority health disparities. Otherwise, the myriad challenges of health care reform could mean that minority health priorities receive insufficient consideration. Given this context, the US Department of Health and Human Services (DHHS) Advisory Committee on Minority Health (ACMH) at its February, 2009 meeting determined that the focus of its present work should be on health care reform from the perspective of improving access and quality of health care for minority and vulnerable communities. The aim of the ACMH is to encourage and support legislative and programmatic health care reform strategies that are guided by key principles and recommendations intended to improve the state of minority health in the US by eliminating disparities. The ACMH acknowledges the work of the DHHS Office of Minority Health, AHRQ and all the collaborating DHHS agencies for programs, initiatives and resources developed and implemented to address health disparities. Their efforts have moved the field forward and informed/shaped health care policy and practice to benefit all communities. At this particular time, however, significant national interest in, and momentum towards, health care reform calls for structuring a health care system that incorporates knowledge and expertise for addressing health disparities as integral elements. Every Full Report 3

15 strategic aspect of health care reform currently being considered, from health insurance coverage to health care access to patient-centered comprehensive services to expanding primary care providers to improving quality of care by improving health care provider training also has the potential to ameliorate health disparities and improve the health of minority communities. Consequently, the Advisory Committee on Minority Health (ACMH) asserts that every such health care reform proposal/strategy must be assessed/ evaluated regarding its implications for ameliorating health disparities and improving the health of minority communities. To facilitate this necessary/critical scrutiny, the ACMH proposes 14 Principles to provide the necessary evaluative criteria. These principles encompass scientifically wellestablished areas of health care policy and health care reform including the need for a diverse health care workforce, equitable access to comprehensive health care coverage and services, the key roles of public health and the safety net, and the need for transparent, accessible, and comprehensive data systems. The ACMH recently completed work on proposing a national multi-component policy strategy for reducing disparities by promoting patient-centered culturally and linguistically sensitive/competent health care. 18 The ACMH urges application of the following 14 Principles to guide the development of health care reform so that addressing health disparities becomes integral to the process of improving access to quality health care and to improving the health status of all communities. This process will also ensure that health care reform will meet the health care needs of minority communities, and create the impetus and infrastructure to eliminate health disparities/inequities. The ACMH also proposes three overarching Recommendations to facilitate/support application of the Principles. A Statement of Principles Designed to Ensure that Health Care Reform Will Meet the Health Care Needs of Minority Communities and Create the Impetus to Eliminate Health Disparities A Diverse Health Care Workforce with Diverse Executive Leadership and Governance Principle 1: The development of a health care workforce that is truly representative and reflective of the communities served is vital for health care reform to achieve its full potential to serve a diverse and growing minority population and to create an affordable and sustainable health care system. Principle 2: The development of diverse executive leadership and governance bodies of the health care system is essential for implementing effective health care reform that meets the needs of a diverse minority population and ensures/works for the elimination of health disparities/inequities. Full Report 4

16 Principle 3: Accrediting and licensing agencies must include strong and robust requirements/benchmarks and oversight processes for ensuring the provision of patientcentered, culturally and linguistically sensitive/competent care in all health care settings. These benchmarks must ensure a diverse health care workforce with diverse executive leadership and governance. Principle 4: Health care professional schools must be affordable and must reflect the diverse communities they serve. Their curricula must promote a trans- and multidisciplinary, team-oriented, and community-responsive approach to teaching, training, mentoring, and matriculating in order to ensure the availability of primary care health care providers necessary to implement comprehensive health care reform. Equitable and Sustainable Access to Comprehensive and Affordable Health Care Coverage and Services Principle 5: High quality health care coverage that is affordable and comprehensive must be equally accessible to all individuals regardless of nativity or citizenship, age or health history. Coverage should be portable to eliminate gaps in coverage due to transitions in employment or life circumstance. Minority and vulnerable communities are disproportionately affected by lack of coverage and access and the consequences of poor health status. Principle 6: A redesigned health care system must be patient-centered and promote a medical home or more broadly a health home for everyone. To improve access for minority and vulnerable communities, financing and reimbursement policies must incentivize and ensure that all persons residing in the US have a health home that emphasizes prevention, primary care, chronic care management and care coordination, and providing patient-centered, culturally and linguistically sensitive/competent care. Principle 7: Health care reform must support the enhancement and availability of a wide range of community-based interventions and program that are responsive to diverse populations, in particular, minority and vulnerable communities. Coordination of patient-centered, culturally and linguistically sensitive/competent care across primary care and medical specialties and sub-specialties must be encouraged through financing and reimbursement systems. Principle 8: While health care reform must create a financially sustainable health care system, new or revised financing and reimbursement policies must not adversely and/or disproportionately affect minority and vulnerable communities. Indeed, such financing and reimbursement policies must redirect resources to minority and vulnerable communities who have always experienced a disproportionate lack of access to the health care system and disproportionately poor health status. Full Report 5

17 Preserve the Safety Net, Focus on Community Engagement and the Social Determinants of Health, Promote Partnerships with Public Health Principle 9: A robust safety net must be maintained to insure that vulnerable and minority populations do not fall through the cracks. Minority and vulnerable communities are those who not able to access affordable health care coverage and/or services and thus disproportionately rely on the safety net, e.g., children in immigrant families, lowincome parents, low-wage working adults with no children, some lawfully residing residents, and undocumented residents in the U.S. Principle 10: Healthcare reform must include minority communities as key stakeholders to provide direct input as to how health care should be structured and delivered. Strong and active minority and vulnerable community engagement is the essential foundation for establishing successful strategies to eliminate health disparities that include meaningful prevention strategies and that account for/address the social determinants of health (SDOH). Principle 11: The public health infrastructure must be strengthened to assure that its primary functions and activities are responsive to a diverse population especially minority and vulnerable communities, and account for/address the social determinants of health (SDOH). Health departments must have the ability to hold their agencies accountable for health disparities as well as the capacity to deal/work with diverse populations in public health emergencies. Minority and vulnerable communities represent a particular challenge/responsibility for public health because these communities disproportionately lack access to health care and health homes. Data Systems Ensure Comprehensive Capacity and Multi-Dimensional Accountability for Eliminating Disparities as well as Achieving Reform Principle 12: The developing area of Health Information Technology (HIT) must support the delivery of a continuum of patient-centered, culturally and linguistically sensitive/ competent care that is seamless and coordinated. HIT/HIE through its datacollection must be used for quality assurance and improvement aimed at eliminating health disparities/inequities. HIT/HIE must go beyond the hospital to include community-based providers and programs that serve minority and vulnerable communities. Principle 13: Data collection strategies must be designed to recognize, measure, evaluate, and address the social determinants of health (SDOH) within the context of the health care system and strategies to improve health outcomes, promote quality assurance, and eliminate health disparities/inequities. SDOH includes environmental influences such as poor housing, unsafe neighborhoods, lack of access to fresh foods, and polluted environments as well as personal behaviors. Full Report 6

18 Principle 14: Data collection strategies, including information on quality, performance, and outcomes, must be transparent and consistent with the benchmarks for eliminating health disparities/inequities as established by the Secretary of HHS or by the federal Health Equity Commission. Measures relevant to and informative of minority and vulnerable communities have been disproportionately absent from data collection and measurement strategies -- this situation must be corrected. The Advisory Committee on Minority Health makes three overarching Recommendations to ensure that the foregoing 14 Principles for Minority Health Equity are effectively incorporated into health care reform activities so that health care reform will meet the needs of minority communities and create the impetus and infrastructure to eliminate health disparities: Recommendation 1: The Administration and the Congress shall take steps to develop and establish a Federal Health Equity Commission (akin to the Federal Civil Rights Commission) that will focus on eliminating health disparities in the US. The Health Equity Commission will provide the stature and clout demonstrably necessary to begin to achieve sustained progress toward the elimination of health disparities/inequities. Recommendation 2: In the meantime, all health care reform commissions, committees, and working groups whether federal or state or local governmental and legislative, public or private think-tank/ngo, must take steps to include sub-committees that address health disparities/inequities, minority health equity, and workforce diversity. It is equally important that these entities take meaningful steps to ensure diversity reflective of communities served in their leadership, membership, and staffing. Recommendation 3: The 14 Principles for including Minority Health Equity in Health Care Reform must be thoroughly considered/addressed in writing by all entities described in Recommendation 2. These reports must be delivered to the Secretary of US Health and Human Services and the Federal Health Equity Commission. Discussion of the 14 Principles for Minority Health Equity A Diverse Health Care Workforce with Diverse Executive Leadership and Governance Full Report 7

19 Principle 1: The development of a health care workforce that is truly representative and reflective of the communities served is vital for health care reform to achieve its full potential to serve a diverse and growing minority population and to create an affordable and sustainable health care system. Principle 2: The development of diverse executive leadership and governance bodies of the health care system is essential for implementing effective health care reform that meets the needs of a diverse minority population and ensures/works for the elimination of health disparities/inequities. Principle 3: Accrediting and licensing agencies must include strong and robust requirements/benchmarks and oversight processes for ensuring the provision of patientcentered, culturally and linguistically sensitive/competent care in all health care settings. These benchmarks must ensure a diverse health care workforce with diverse executive leadership and governance. Principle 4: Health care professional schools must be affordable and must reflect the diverse communities they serve. Their curricula must promote a trans- and multidisciplinary, team-oriented, and community-responsive approach to teaching, training, mentoring, and matriculating in order to ensure the availability of primary care health care providers necessary to implement comprehensive health care reform. Discussion The 2004 IOM report, In the Nation's Compelling Interest: Ensuring Diversity in the Health Care Workforce, 19 that complemented Unequal Treatment 20 called for increased diversity in the health care workforce as part of a comprehensive strategy to reduce health disparities. This report cited that more than 40 percent of Hispanic patients in one survey said that a doctor s ability to speak the patient s language was a significant consideration in choosing a physician and that minority patients are more likely to choose health care professionals from their own ethnic groups and are more satisfied with the care that they receive from them. Evidence indicated that patient-physician communication, trust and understanding increase when patients share the same ethnic, racial, or cultural or primary language background; this improves the accuracy of diagnoses and frequency of patient compliance. The IOM stressed the impact of the landmark decision in the U.S. Supreme Court ruled in Grutter v. Bollinger et al. that it was lawful for the University of Michigan Law School to consider race and ethnicity as one of many factors in the admissions process because the practice was narrowly tailored and did not violate the constitutional rights of nonminority applicants. It was in this ruling that Justice Sandra Day O Connor wrote: Effective participation by members of all racial and ethnic groups in the civic life of our Nation is essential if the dream of one Nation, indivisible, is to be realized. 21 Full Report 8

20 This IOM Committee recognized that by 2050 the US may be 50 percent non-white or not primarily English-speaking, and that better patient care will depend on better crosscultural understanding. The Committee s report cited that African-American physicians in California were five times more likely than their white peers to practice in largely African-American communities while the proportion of African-American physicians to the general population and commensurate with their portion of population is shrinking. Data from the 2001 Commonwealth Fund Survey indicated that Asian Americans overall (27%) and Asian Americans ethnic subgroups such as Koreans (41%), Chinese (35%), and Asian Indians (28%) were more likely to experience communication difficulties with their provider compared to the general population at 19%. 22 Sinkford and Valachovic (2001) have shown that Asian Dentists are more likely to serve other communities of colors than are white dentists and in fact serve a meaningful proportion of black (11.5%) and Hispanic (14.5%) patients. 23 In 2007, Ngo-Metzger and colleagues examined the importance of language concordance between providers and LEP patients as related to health education, interpersonal care, and lower patient satisfaction. Their study of 2,746 Chinese and Vietnamese patients confirmed that language concordance between providers and patients is still the optimal situation. They also demonstrated that interpreters could have a positive impact in promoting health education although having an interpreter did not substantively mitigate the impact of having a language-discordant provider. 24 The IOM Committee discussed these benefits of racial and ethnic diversity among health care professionals: (1) Racial and ethnic minority health care providers are more likely to serve minority and medically underserved communities, thereby increasing access to care; (2) Racial and ethnic minority patients report greater levels of satisfaction with care provided by minority health care professionals; (3) Racial and ethnic minority health care providers can help care systems efforts to reduce cultural and linguistic barriers and improve cultural competence; (4) Diversity in higher education/health care professions training settings is associated with better educational outcomes among all students. 25 The IOM recommended to Health Professions Education Institutions and relevant public and private groups mechanisms to encourage support for diversity efforts with: (1) Additional research and data collection on diversity and its benefits; (2) Efforts to increase broad stakeholders understanding of and consensus regarding steps that should be taken to enhance diversity among health care professionals; and, (3) The development of broad coalitions to encourage HPEIs, their accreditation bodies, and federal and state sources of health care professions student financial aid to adopt policies to enhance diversity among health care professionals. 26 In the Nation's Compelling Interest was followed in the same year by the Sullivan Commission that pointed to the clear, critical need for more health care professionals and support personnel from ethnic or racial minority groups and that such individuals are more likely to serve minority and medically underserved communities. 27 Together, Full Report 9

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MEDICARE EXTENDERS Part B Payments to Indian Hospitals and Clinics. (Sec. 2902) Spends $200 million over 10 years. Section 630 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003

Standards for Quality, Affordable for Health Care for All: Health Care for All New York (HCFANY) believes that every resident of New York State and the nation must have access to affordable and comprehensive

Department of Family Medicine and Community Health University of Massachusetts Medical School UMass Memorial Health Care Worcester, Massachusetts October, 2009 Our Vision: Our Department will be nationally

Page 1 of 10 Key Features of the Affordable Care Act, By Year On March 23, 2010, President Obama signed the Affordable Care Act. The law puts in place comprehensive health insurance reforms that will roll

Health for Life Better Health Better Health Care National Framework for Change Health Coverage for All Paid for by All Focus on We llness Health Coverage for All Paid for by All Nearly one in five people

The governmental public health system in the United States is comprised of federal agencies, state health agencies, tribal and territorial health departments, and more than 2,500 local health departments.

Mental Health: Culture, Race and Ethnicity 1) The largest disability study conducted in the US found that of disabled adults living in the community reported having a mental disorder contributing to their

American Association for Community Dental Programs The NPA Journey and Why It Matters to Oral Health OMH and the Drivers for Change Aligning with Healthy People 2020 NPA Development All Interested Partners

Improved Medicare for All Quality, Guaranteed National Health Insurance by HEALTHCARE-NOW! Single-Payer Healthcare or Improved Medicare for All! The United States is the only country in the developed world

American Public Health Association NOVEMBER 2008 Evaluating the Economic Causes and Consequences of Racial and Ethnic Health Disparities Kristen Suthers, PhD, MPH Racial and ethnic health disparities are

Issue Brief may 15 The COMMONWEALTH FUND Mobile Health and Patient Engagement in the Safety Net: A Survey of Community Health Centers and Clinics The mission of The Commonwealth Fund is to promote a high

Access to Care / Care Utilization for Nebraska s Women According to the Current Population Survey (CPS), in 2013, 84.6% of Nebraska women ages 18-44 had health insurance coverage, however only 58.2% of

Clinical Research, Inclusion, and You A Scientific Forum, was the signature event for National Women s Health Week at NIH activities and the annual ORWH scientific seminar. The scientific forum explored

What Works: Reducing Health Disparities in Wisconsin Communities A Review of Evidence-based Practices to Improve Access to Primary and Preventive Health Services for African American and Latino Communities

August 10, 2015 Joyce Cofield Sheila Clark Executive Office of Minority and Women Inclusion Office of Minority and Women Inclusion Office of the Comptroller of the Currency Board of Governors of the Federal

An Equity Profile of the Houston-Galveston Region PolicyLink and PERE An Equity Profile of the Houston-Galveston Region Summary Overview Across the country, regional planning organizations, community organizations

Reach Higher, AMERICA OVERCOMING CRISIS IN THE U.S. WORKFORCE EXECUTIVE SUMMARY Report of the National Commission on Adult Literacy June 2008 Council for Advancement of Adult Literacy EXECUTIVE SUMMARY

Timeline: Key Feature Implementations of the Affordable Care Act The Affordable Care Act, signed on March 23, 2010, puts in place health insurance reforms that will roll out incrementally over the next

The Promise of Regional Data Aggregation Lessons Learned by the Robert Wood Johnson Foundation s National Program Office for Aligning Forces for Quality 1 Background Measuring and reporting the quality

PIPC: Hepatitis Roundtable Summary and Recommendations on Dissemination and Implementation of Clinical Evidence On May 8, 2014, the Partnership to Improve Patient Care (PIPC) convened a Roundtable of experts

A PHILANTHROPIC PARTNERSHIP FOR BLACK COMMUNITIES Health and Wellness BLACK FACTS THE COST OF MAINTAINING A HEALTHY DIET FOR A FAMILY IS OUT OF REACH FOR MANY AFRICAN AMERICAN FAMILIES. 2 A Philanthropic

HORIZONS The 2013 Dallas County Community Health Needs Assessment EXECUTIVE SUMMARY The Dallas County Community Health Needs Assessment (CHNA) was designed to ensure that the Dallas County public health

American Association for Community Dental Programs Implementing The Federal Health Equity Agenda April 10, 2011 The NPA Journey and Why It Matters to Oral Health OMH and the Drivers for Change Aligning

Toward Meaningful Use of HIT Fred D Rachman, MD Health and Medicine Policy Research Group HIE Forum March 24, 2010 Why are we talking about technology? To improve the quality of the care we provide and

PREPARED STATEMENT OF YVONNE T. MADDOX, PH.D. Mr. Chairman and Members of the Committee: I am pleased to present the President s Budget for the National Institute on Minority Health and Health Disparities

WINNING THE SKILLS RACE AND STRENGTHENING AMERICA S MIDDLE CLASS: An Action Agenda for Community Colleges Findings and Recommendations from the National Commission on Community Colleges 1 Nat l Commission

Goal Area Agency Objective Strategic Activity Benchmarks Increase access to VA resources such as small and disadvantaged business development counseling and small business loans to ensure AAPIs have needed

7th Biennial Symposium on Minorities, the Medically Underserved and Cancer Supplement to Cancer 199 The Unequal Cancer Burden Efforts of the Centers for Disease Control and Prevention to Bridge the Gap